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Arrival at Makunda

We write this after our first full day at Makunda Christian Hospital. To say that the world in which we live in now is 180 degrees different from the life we lived in Minnesota would only capture a little of life here. We left the hotel in Kolkata around 9:30 in the morning having learned from our prior airport stop in Bangalore to leave much more time so that we wouldn’t end up nearly missing the flight again. If any of you will be traveling to Kolkata sometime consider staying at the O2 hotel there…we had a great experience with them and the day at the hotel really helped to rejuvenate us before the last leg of our journey.

After arriving at the airport we were pleasantly surprised by how easy it was to navigate our way through and arrive at the right location. Although then we found out that our 1 PM flight was delayed by almost an hour and a half and thus we had quite a long wait at the airport. However, both the kids loved playing with the luggage carts and put on quite a show for the rest of the passengers waiting in the airport terminal. Our Indian Airlines flight from Kolkata to Silchar was notable for a good lunch meal (in a flight that was about 1 hour…when was the last time we saw a meal being served on such a short flight in America?) and one of the worst landings on our trip so far which made us very thankful to be on the ground again.

Silchar airport has one terminal – really a glorified room (for all of us who are amused at how small of an airport Rochester has, we stand corrected!) and thankfully the driver from Makunda was easily able to locate us from the crowd departing the airport. Our driver was so gracious because he had actually arrived a day earlier looking for us because some information got miscommunicated and so he had been looking for us on each flight that arrived there! We then began the 120 km journey from Silchar to Bazaricherra where Makunda is located. This drive took us about four hours because several parts of the road are nonexistent and there were tons of border patrols throughout our journey. The road from Silchar to Makunda runs very close to the Bangladesh border so there is a big problem with border crossings and especially with terrorists that cross over into India through this area. Thus most of the women get some type of army escort when they travel because it is not safe for them to be alone due to terrorist activity among the local tribes. Also during the rainy season the highway is often completely flooded over and thus roads can be completely closed for several months at a time. Just as a side note, the difficulty with highway travel makes it hard for pregnant mothers to get to a larger hospital and thus deliveries at Makunda have increased significantly since it is easily accessible to a large number of local patients. Our driver was excellent and helped us navigate this treacherous journey and helped us arrive safely at Makunda around 8 PM on Sunday night.

The hospital administrator, Jonathan and his wife, Lydia did a great job in getting some living quarters ready for us and thus we were thankful that we could just work on eating dinner and getting the kids to bed. The building that we are living in was built in the 1950s but the place reminds us of how things must have been a hundred years ago. There is electricity available at our home but it is periodic at best and there is no running water (the wells have run dry and thus water now has to brought up to each of the buildings daily and stored in some large buckets for use throughout the day). Our first night was a little harrowing because the rainy season has begun here and there was a horrible storm during the night that sounded extremely loud because our building has a thatched bamboo roof that is covered by a tin room. Even though we couldn’t sleep very well overnight the kids were so tired that they slept with no problem! Praise God that He kept us safe through a bad storm. Because of the storm, several trees fell over power lines and from what we have found out it will now take several days for the electricity to come back again.

Monday morning was an early morning. The sky starts to lighten up here by about 4:30 to 5 AM and because we live in a forest the birds start talking around the same time and thus we have gotten up much earlier that we were used to back in the U.S. By about six AM, a lady who comes to help another doctor who lives in the same compound as we do came to help us with breakfast and lunch. She speaks no English and we don’t speak Bengali or her tribal language and thus the morning was filled with much gesturing and empty looks. However, she did make us a wonderful breakfast and helped us with washing laundry and cleaning around the house. One of the biggest things our kids have had to get adjusted to has been the lack of a refrigerator. It is one of those appliances that we so took for granted in the US but now don’t have that luxury anymore. Here we cook meals one at a time because most food will spoil in the heat here. It has also meant no milk for the kids until we find out a way to get milk daily since there is no way for us to keep it from going bad.

Christo’s first day in the hospital was an eye opening experience and one in which he learned much. Mornings at the hospital start around 8:30 with morning rounds with the 90 patients in the hospital wards before moving on to start the outpatient clinic. It is amazing to see how efficient the doctors are here, especially Dr. Vijay and Dr. Ann, his wife. We probably saw all the patients and made treatment decisions in about 45 minutes. The hospital is one of meager means and there are no private rooms available for patients. The goal of being able to serve the poor at a low cost is very clearly apparent and they do a wonderful job. During rounds we saw three patients with cerebral malaria, one school aged girl with diphtheria, several post-op patients (ranging from perforated duodenal ulcer to C-sections to a uretero-vesicular anastomosis and recreated anus for a baby with imperforate anus). There is also another patient on the wards who currently has tetanus. There is another patient that has a 5 cm bladder stone and many more with your everyday pneumonia. On the maternity ward there is a patient who just had a C-section who we just found out has severe dilated cardiomyopathy with an ejection fraction of 32%.

After morning rounds we started the outpatient clinic which typically sees between 150-250 patients a day. There are currently the two senior physicians (Dr. Vijay, a pediatric surgeon; Dr. Ann (Dr. Vijay’s wife), an anesthesiologist; Dr. Anchily, a resident in family medicine on loan to Makunda from Tezpur Baptist Hospital; Dr. Rochfuii, an intern). Dr. Anchily and Dr. Rochfuii have just been here a few day and thus all of us are trying to learn a new system and a new language. Today was a fairly non-busy day because quite a few villagers were not able to get to the hospital due to the storm the night before. During the day as we see patients in the OPD, serious patients continue to come in. This day we had a lady in her sixties come carried in by her family. From what we understood she stopped moving the right side of the body the day before and within a couple of hours had become unconscious. However the family only decided to bring her in the next day – something quite typical here. By the time we examined her there was just withdrawal to pain on the right side and she was unconscious but still breathing. We explained to the family that this was a very serious case and that she could die within the next 48-72 hours and that she should go to a bigger facility where they can do a CT scan to see if there was active intracranial hemorrhage. The family did not have the means for that and thus they signed a high risk consent and we admitted the patient.

The days here are also interrupted multiple times by deliveries both normal and C-sections. Today we had three vaginal deliveries and in the evening Dr. Vijay did one more C-section. We also admitted several patients with preeclampsia, something that seems to be fairly common here. Late in the day another toddler came in with severe tachypnea and fever. Chest X-Ray showed complete opacification of the left lung and thus he was admitted for treatment of pneumonia. Our hope is that we can ultrasound him the next day to see if there is a fluid collection in his thorax and if so then we can tap the fluid to get a better idea of what type of infection he has. In the OPD we also several patients with tuberculosis since that is very common in this area especially TB with multi-drug resistance.